Provider Demographics
NPI:1386083913
Name:TAM, LARRY (DDS)
Entity type:Individual
Prefix:
First Name:LARRY
Middle Name:
Last Name:TAM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1715
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-0030
Mailing Address - Country:US
Mailing Address - Phone:972-850-8261
Mailing Address - Fax:
Practice Address - Street 1:3460 W WALNUT ST STE 600
Practice Address - Street 2:
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-7118
Practice Address - Country:US
Practice Address - Phone:972-850-8261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-17
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX28928122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist